Anti Microbial Resistance

Introduction

India is severely affected by anti microbial resistance and this has increased the burden of diseases. It is important for the government to initiate several measures from creating awareness to policies that shall be instrumental to address the same.

Chennai Declaration:

“The Chennai Declaration” named after the city where the meeting took place, is the consensus evolved out of the meeting and co-authored by representatives of various medical societies.

The document is based on realistic goals and objectives, with a deep understanding of the background Indian scenario.

Over the last decade or two, the Indian health-care infrastructure underwent significant changes. While possessing many world-class corporate hospitals and institutes, the facilities available in many villages and remote areas are still vastly inadequate.

Medication including antibiotics may be purchased over the counter and/or are prescribed by practitioners from alternative medical branches and healers.

Formulating and implementing an antimicrobialstewardship program in one of the largest countries, with an enormously heterogenic and diverse health-care system, is indeed a huge challenge. Strict control on over the counter sale (OTC) as well as in hospital antibiotic usage should be the first steps of the policy.

Whether such a policy is implementable on the Indian subcontinent is an issue that warrants serious debate.

The lack of (qualified) doctors in many remote places possibly makes the complete ban of OTC antibiotics throughout the country obsolete.

Consequently, a targeted strategy of absolute control in densely populated areas, where qualified doctors will be available, and a more liberal approach in remote places, with monitoring of a selected list of oral antibiotics, should be more feasible.

Issue:

One of the most critical concerns facing the global health fraternity today is the escalating burden of antimicrobial resistance (AMR).

AMR develops as result of microorganisms such as bacteria, viruses, fungi and parasites becoming immune to antimicrobial drugs such as antibiotics. These microorganisms are commonly known as superbugs.

Over the past decades, antimicrobial agents have been instrumental in alleviating communicable diseases across the world.

While antibiotic resistance is a global hazard to public health, India, the largest consumer of antibiotics in the world, is notoriously seen as the epicentre of this threat.

Increasing infections:

Last year, India saw a 70-year-old woman from the US died after contracting a superbug during a two-year residence in the country.

Doctors in the US say the patient was infected with a multidrug-resistant organism known as carbapenem-resistant Enterobacteriaceae (CRE) which is immune to all available antibiotics.

In the recent past, India has witnessed many large outbreaks of emerging infections and most of them were of zoonotic origin (diseases transmitted from animals to humans).

While exact figures are hard to come by, WHO’s Global Burden of Disease report of 2004 suggests a 15-times greater burden of infectious diseases per person in India than in the UK.

According to the calculations based on World Bank data and the Global Burden of Disease report of 1990, the crude infectious disease mortality rate in India today is 416.75 per 100,000 persons, which is twice the rate prevailing in the US.

The US Center for Disease Control and Prevention estimates that in the US, more than two million people fall sick every year due to antibiotic-resistant infections, resulting in at least 23,000 deaths.

In India, the threat is much more pressing. According to the Indian Network for Surveillance of Antimicrobial Resistance (INSAR), there is widespread existence of superbugs throughout the country including a startling 41 per cent of methicillin-resistant Staphylococcus aureus (MRSA).

Multi-resistant Entero-bacteriaceae has also become rampant.

On the one hand, infectious diseases are on the rise; on the other, AMR is posing a serious impediment in their cure.

Hospital-acquired infection in vulnerable patients with resistant strains is another major threat.

Resistance to antimicrobial drugs also means that the success of treatments for medical procedures such as chemotherapy and organ transplantation and post-surgical recovery come under immense risk.

All these effects of AMR have substantial repercussions on the socio-economic set up.